Lip Filler Injection: Needle VS Micro-cannula?

According to Lip Reshaping with LOVE Approach: A Prospective Analysis Based on Two Hyaluronic Acid Fillers published on Last Reconstr Surg Glob Open (Nov 2021), aesthetic improvement of the lips with hyaluronic acid fillers is a popular procedure. The mouth and lips are key features of an aesthetically pleasing face, and play an important role in human interaction.


For example, the mouth area is fundamental to conveying happy facial expressions, whereas the size and shape of the mouth and lips have been linked with creating an impression of approachability. Upper lip height may also be an important correlate of perceived attractiveness, successfulness, and overall health.


Hence, it is not surprising that adequate lip volume and a sharp lip border have come to represent important social features of youth and beauty.





LOVE Approach


The LOVE technique with HA uses two different HA filler products across three modules of lip treatment, focusing on shape, volume, and hydration, respectively.



Image above shows the approach to aesthetic lip treatment with hyaluronic acid fillers, showing all three modules combined (A), and the shape (B), volume (C), and hydration (D) modules separately.


LOVE was designed primarily for advanced practitioners, but its versatility and targeted use of different fillers may help minimize complications, and hence potentially make the techniques more accessible to less experienced injectors. Nonetheless, great care is always required when treating the lips.


Proper placement and depth of injection determines the aesthetic and functional outcome. Too superficial of an injection may lead to a “speed bump” appearance of the upper lip, while too deep an injection may fail to accentuate the white roll of the lip. The lip also contains the superior labial artery, which must be avoided during injection.


Even though across most approach the fundamentals are similar, one potential variable in the position of HA gel is the use of either a microcannula or a needle.


NEEDLE Injection



The most popular method of applying lip filler is with regular needles. A doctor will use hard needles with a sharp end to inject into a number of specific places. They will then lightly massage the region to spread the product evenly and limit the risk of edema. Standard lip fillers are typically injected horizontally into the lip, resulting in a uniform distribution of volume and fullness.


This approach allows for higher precision as placement of the needle tip & it allows for doctors with prior experience on injection with needle to lesser time master.



MICRO-CANNULA Injection



Microcannula, also known as blunt tip needles are gaining popularity and often preferred over needles due to many advantages that it provides.


One of which is the single entry point, to first puncture with a larger bore needle before the inserting through the opening. Comparing to needle injection, this significantly reduces point of injection during the procedure and also due to their length using microcannulas allows for a bigger area of treatment within that one point of entry.


Unlike needles, a micro-cannula provides less risk of vascular occlusion according to anatomical evidence-based research because needles can easily penetrate a blood vessel during injection, where cannulas with blunt ends carry a lower risk.


COMPARISON



Cannula produced more consistent distribution of filler, but that it deposited filler further from the intended subcutaneous plane when compared with the needle injections.


The single cannula injection, compared with multiple injection points required for the 1⁄2-inch needle, may account for the more consistent distribution of material using the cannula. While the cannula injections were more consistent, they produced a higher percentage of intramuscular filler.


This may be due to the pointed shape of the stab incision needle exposing slightly deeper tissue planes, the blunt nature of the cannula decreasing tactile feedback to find the immediate subcutaneous plane, and dense subcutaneous attachments with a thin subcutaneous plane not allowing for placement of the blunt, larger cannula within the plane.


CONCLUSION


The conventional technique does not provide much artistry in reshaping the lips; therefore, most clinicians tend to use the needle alone or with a cannula to fulfil this purpose. But from an aesthetic view point, both needle and cannula can achieve similar results. However, optimal placement and results ultimately depend upon the knowledge and skill of the injector.



REFERENCE

Microanatomical Location of Hyaluronic Acid Gel Following Injection of the Upper Lip Vermillion Border: Comparison of Needle and Microcannula Injection Technique published on The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. (2017)

Lip Reshaping with LOVE Approach: A Prospective Analysis Based on Two Hyaluronic Acid Fillers published on Last Reconstr Surg Glob Open (Nov 2021)

How I Do It - Approaches to lip augmentation: Perioral rejuvenation – a multi-product approach

By Simon Ravichandran and Emma Ravichandran (2018) https://www.thepmfajournal.com/education/how-i-do-it/post/how-i-do-it-approaches-to-lip-augmentation-perioral-rejuvenation-a-multi-product-approach

A New Approach for Lip Filler Injection Using an Inverted Mercedes Benz Sign published on Oral and Maxillofacial Surgery Specialist, Cairo, Egypt. (Dec 2021)

Different Lip filler injection techniques published on Dermagical (2019)

Why choose the micro-cannula for lip injections? Published on SoftFil (2021)

Dermal Filler Cannula published on Alyssagan (2021)

Cannula vs. Needle for Dermal Fillers by MOJGAN HOSSEINIPOUR (Feb 2021)


 


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